Non-surgical laser treatment for a fibrous mass

ABSTRACT

A method for treating a fibrous mass, which comprises a Morton&#39;s neuroma or a plantar firbroma. The method comprises identifying a location of the fibrous mass, determining a first size of the fibrous mass, non-surgically delivering electromagnetic energy to the fibrous mass, and determining a second size of the fibrous mass.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority to, and the benefit of, U.S.Provisional application Ser. No. 62/198,787, filed on Jul. 30, 2015,titled “Non-surgical Laser Treatment for Morton's Neuroma,” and to U.S.Provisional application Ser. No. 62/297,693, filed on Feb. 19, 2016,titled “Non-surgical Laser Treatment for Plantar Fibroma,” both of whichare incorporated herein by reference.

FIELD OF THE INVENTION

This invention relates to a non-surgical treatment for a fibrous mass,such as Morton's neuroma and plantar fibroma.

BACKGROUND OF THE INVENTION

Perineural fibrosis with axonal degeneration and vascular proliferationof the common digital nerve of the second or third intermetatarsal spaceare often referred to as a Morton's neuroma. It is believed thatfibrosis along with degeneration of the nerve occurs as a result ofmechanical irritation or entrapment between the adjacent metatarsalheads. Pain, tingling and numbness are the most common symptoms. Paincan progress to lifestyle limiting.

Referring now to FIG. 1, Morton's neuroma (also known as Morton neuroma,Morton's metatarsalgia, Morton's neuralgia, plantar neuroma,intermetatarsal neuroma, and interdigital neuroma) is a benign neuromaof an intermetatarsal plantar nerve, most commonly of the second andthird intermetatarsal spaces (between 2nd-3rd and 3rd-4th metatarsalheads).

Prior art treatment has included shoe modification, use of orthoticdevices, corticosterioid injections, alcohol sclerosing injections, andsurgical neurectomy.

A fibroma is a non-cancerous, i.e., benign, fibrous tissue tumor orgrowth, that can occur anywhere in the body. For example, on theplantar, or the bottom surface of the foot, the fibromas are calledplantar fibromas. Unlike plantar warts, which grow on the skin, plantarfibromas grow within the plantar fascia, which is a thickened, fibroussheet of connective tissue that originates from the plantar aspect ofmedial tubercle of the calcaneus and extends to the plantar plates ofthe metatarsophalangeal joints with a function of absorbing shock forthe foot during ambulation. The plantar fascia is one of the mostimportant ligamentous bands that maintain the longitudinal arch of thefoot.

The etiology of plantar fibromas have not been clearly identified, butit is more than likely multifactorial. The typical etiology isrepetitive stress overload to the origin of the plantar fascia, togetherwith other causes, such as weight gain, excessive pronation,occupation-related activity, anatomical variations, altered biomechanics(i.e., gait abnormalities), overexertion, and inadequate foot wear.

Plantar fibromas can develop in one or both feet and the common growthis usually a solitary nodule, though multiple nodules are possible inthe same foot. The mid-arch region of the foot is the most commonlocation for planter fibromas to develop. However, plantar fibromas canappear anywhere along the underside of the foot. They can occur inpeople of any age and gender and will not resolve on their own or becomesmaller without proper treatment.

Prior art treatment can be divided into conservative and surgicalmeasures. Conservative and prior art non-surgical measures can alleviatethe pain of a plantar fibroma, but they will not reduce the mass orprevent the progression of the plantar fibroma. These measures typicallyinclude steroid injections, orthotic devices (i.e., orthopedic shoeinsoles), anti-inflammatory drugs, and physical therapy. Operativemeasures are needed when the above measures fail to improve symptoms ofthe plantar fibroma. However, surgical removal of the plantar fibromarequires outpatient care and may result in a flattening of the arch ordevelopment of hammertoes. Recurrence of the plantar fibroma occurs evenafter surgical measures.

SUMMARY OF THE INVENTION

Embodiments of applicant's disclosure describe a method for treating afibrous mass, which comprises a Morton's neuroma or a plantar fibroma.The method comprises identifying a location of the fibrous mass,determining a first size of the fibrous mass, non-surgically deliveringelectromagnetic energy to the fibrous mass, and determining a secondsize of the fibrous mass. The method further comprises determining anumber of a plurality of treatments. In some embodiments, when treatingthe Morton's neuroma, the method further comprising manipulating theMorton's neuroma into a position adjacent a surface of the patient'sfoot.

In certain embodiments, medical imaging techniques, such as ultrasoundimaging and magnetic resonance imaging, are used to identify thelocation of the fibrous mass and to determine the first size of thefibrous mass. In other embodiments, identifying the location of thefibrous mass further includes placing a patient in a supine position,palpating the patient's skin over a suspected location of the fibrousmass, and detecting an audible click when palpating skin directly overthe fibrous mass.

In certain embodiments, the delivering electromagnetic energy to thefibrous mass step further comprises emitting electromagnetic energy froma lasing device in about a 5 mm diameter beam, adjusting a power of tothe lasing device such that the electromagnetic energy penetratestissues to a depth of about 6 mm to about 8 mm, directing the 5 mm beamonto the location for a length of time between about 10 minutes to about15 minutes, and delivering about 1,000 pulses of the 5 mm beam to thelocation. In some embodiments, a Nd:YAG lasing device can be utilized.

In certain embodiments, a topical medication is applied directly on theskin of the location of the fibrous mass. The topical medication isselected from a group consisting of cream, gel, ointment, and lotion. Insome embodiments, the applying the topical medication step furthercomprises using about 15% verapamil by weight, about 3% pentoxifyllineby weight, and about 1% tranilast by weight. In other embodiments, theapplying the topical medication step further comprises using about 15%verapamil by volume, about 3% pentoxifylline by volume, and about 1%tranilast by volume.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention will be better understood from a reading of the followingdetailed description taken in conjunction with the drawings in whichlike reference designators are used to designate like elements, and inwhich:

FIG. 1 illustrates the anatomy of the medial plantar nerve and thelateral plantar nerve;

FIG. 2 is a flowchart summarizing the steps of Applicant's method fortreating Morton's neuroma;

FIG. 3 illustrates the anatomy of the plantar fascia and the plantarfibroma;

FIG. 4 is a flowchart summarizing the steps of Applicant's method fortreating plantar fibroma;

FIG. 5A is an ultrasound image showing a plantar fibroma before thelaser treatment; and

FIG. 5B is an ultrasound image showing the plantar fibroma that isreduced in size after the laser treatment.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

This invention is described in preferred embodiments in the followingdescription with reference to the Figures, in which like numbersrepresent the same or similar elements. Reference throughout thisspecification to “one embodiment,” “an embodiment,” or similar languagemeans that a particular feature, structure, or characteristic describedin connection with the embodiment is included in at least one embodimentof the present invention. Thus, appearances of the phrases “in oneembodiment,” “in an embodiment,” and similar language throughout thisspecification may, but do not necessarily, all refer to the sameembodiment.

The described features, structures, or characteristics of the inventionmay be combined in any suitable manner in one or more embodiments. Inthe following description, numerous specific details are recited toprovide a thorough understanding of embodiments of the invention. Oneskilled in the relevant art will recognize, however, that the inventionmay be practiced without one or more of the specific details, or withother methods, components, materials, and so forth. In other instances,well-known structures, materials, or operations are not shown ordescribed in detail to avoid obscuring aspects of the invention.

Referring now to FIG. 1, perineural fibrosis of the common digital nerveof the second or third intermetatarsal space is often referred to as aMorton's neuroma. It is believed that fibrosis along with degenerationof the nerve occurs as a result of mechanical irritation or entrapmentbetween the adjacent metatarsal heads. Pain, tingling and numbness arethe most common symptoms. Pain can progress to lifestyle limiting.

Applicant has found that Morton's neuroma can be effectively treatedusing non-surgical treatments of laser energy. Surgery is a technologyconsisting of a physical intervention on tissues, and muscle. As ageneral rule, a procedure is considered surgical when it involvescutting of a patient's tissues or closure of a previously sustainedwound. Applicant's method to treat Morton's neuroma neither involvescutting of a patient's tissues, nor closure of a previously sustainedwound.

Other procedures, such as angioplasty or endoscopy, may be consideredsurgery if they involve “common” surgical procedure or settings, such asuse of a sterile environment, anesthesia, antiseptic conditions, typicalsurgical instruments, and suturing or stapling. Applicant's method totreat Morton's neuroma does not require a sterile environment,anesthesia, antiseptic conditions, surgical instruments, suturing, orstapling.

FIG. 2 summarizes the steps of Applicant's method for treating Morton'sneuroma. Referring now to FIG. 2, in step 205 the method verifies thepresence of a Morton's neuroma using one or more medical imagingtechniques. Such medical imaging techniques include, without limitationmagnetic resonance imaging (“MRI”) and/or ultrasound imaging.

In certain embodiments, the target area of the neuroma is identifiedusing Applicant's “Dull Probe Technique,” wherein that techniqueincludes using a dull probe while patient is in the supine position,palpating the intermetatarsal space to elicit pain consistent with theirchief complaint and/or a positive Mulder's sign (an audible click). Adiagnostic ultrasound is also used to identify the specific location ofthe neuroma. The target area is marked on the plantar surface of foot toguide laser treatment.

In step 210, and based upon the medical imaging of step 210, set ananticipated number of weekly, non-surgical laser treatments. In step220, the method sets a variable (i) to 1.

In step 230, the method manipulates the verified Morton's neuroma into aposition adjacent to a surface of the patient's foot. In step 240, themethod positions a lasing device such that output power emitted by thatlasing device is directed onto the surface of the patient's footdirectly over the plantar surface of the Morton's neuroma.

In certain embodiments, step 230 further comprises applying a topicalmedication to the surface of the foot directly over top of the Morton'sneuroma. Applicant's topical medication is made by a compoundingpharmacy and comprises Verapamil 15%, Pentoxifylline 3% and Tranilast1%. The medication is applied just prior to the laser treatment and isallowed to absorb.

Applicant's topical medication is used to treat fibrotic conditions,like plantar fibromas and Dupuytren contracture and scarring. Applicanthas found that use of this topical medication assists treatment of thefibrosis around the nerve when used with the Nd:YAG laser.

In certain embodiments, the lasing device of step 240 comprises a Nd:YAGlaser.

In step 250, the method configures the lasing device of step 240 to emitelectromagnetic energy in a beam of a about 5 mm spot size diameter. Instep 260, the method configures the lasing device such thatelectromagnetic energy emitted by that lasing device penetrates tissuesof the foot to a depth of between 6 mm and 8 mm. Applicant hasdemonstrated with magnetic resonance imaging that this tissue depth issufficient to reach the candidate nerve.

In step 270, the method energizes the lasing device for between about 10to about 15 minutes. In step 280 in certain embodiments, the methodnon-surgically delivers about 1,000 pulses of electromagnetic energy at15 J/cm², 6 msec and 7 Hz to the Morton's neuroma. Step 180 does notinclude cutting of the patient's skin. More specifically, step 180 doesnot include cutting the patient's skin disposed over or adjacent to thepalpated Morton's neuroma. Step 180 does not include closure of apreviously sustained wound.

In step 280 in certain embodiments, the method non-surgically deliversabout 1,000 pulses of electromagnetic energy to the Morton's neuroma.

In step 290, the method determines if (i) equals (N). If the methoddetermines in step 290, that (i) does not equal (N), then the methodtransitions from step 290 to step 292 wherein the method increments (i)by 1, i.e. sets (i) equal to (i+1), The method then transitions fromstep 292 to step 230 and continues as described herein.

If the method determines in step 290, that (i) does equal (N), then themethod transitions from step 290 to step 295 wherein the method reimagesthe Morton's neuroma.

Referring now to FIG. 3, a fibrous knot or nodule that is embeddedwithin the planter fascia is often referred to as a plantar fibroma.More invasive, rapid-growing fibromas are considered plantarfibromatosis. The characteristic sign of a plantar fibroma is anoticeable lump in the arch or instep, between the heel pad and theforefoot pad. The typical plantar fibroma appears as a focal, oftenoval-shaped area with disorganization within the plantar fascia. Largerlesions may be lobulated and can demonstrate a central scar-likeappearance with fibers radiating from the plantar fascia. The mass willcause a soft convexity in the contour of the bottom of the foot that maybe painful with pressure. Also, prolonged walking and wearing shoes cancause pain or discomfort. In some cases, the mass of the plantar fibromacan progress to cause pain to limit patients' lifestyles.

Applicant has found that plantar fibromas can be effectively treatedusing non-surgical treatments of laser energy. Surgery is a technologyconsisting of a physical intervention on tissues, and muscle. As ageneral rule, a procedure is considered surgical when it involvescutting of a patient's tissues or closure of a previously sustainedwound. Applicant's method to treat plantar fibromas neither involvescutting of a patient's tissues, nor closure of a previously sustainedwound.

Other procedures, such as angioplasty or endoscopy, may be consideredsurgery if they involve “common” surgical procedure or settings, such asuse of a sterile environment, anesthesia, antiseptic conditions, typicalsurgical instruments, and suturing or stapling. Applicant's method totreat plantar fibromas does not require a sterile environment,anesthesia, antiseptic conditions, surgical instruments, suturing, orstapling.

FIG. 4 summarizes the steps of Applicant's method for treating plantarfibroma. Referring now to FIG. 4, in step 405 the method verifies thepresence of a plantar fibroma using one or more medical imagingtechniques. Such medical imaging techniques include, without limitation,magnetic resonance imaging (“MM”) and/or ultrasound imaging.

In certain embodiments, the target area of the fibroma is identifiedusing Applicant's “Dull Probe Technique,” wherein that techniqueincludes using a dull probe while patient is in the supine position,palpating the arches of the foot to elicit pain consistent with his/herchief complaint. A diagnostic ultrasound is also used to identify thespecific location of the fibroma. The target area (including size,shape, and boarders of the plantar fibroma) is marked on the plantarsurfaces and/or the arches of foot to guide laser treatment.

In step 410, and based upon the medical imaging of step 410, the methodsets an anticipated number of weekly, non-surgical laser treatments. Instep 420, the method sets a variable (i) to 1. In certain embodiments,the anticipated number of weekly, non-surgical laser treatments equalsto 10.

In step 430, the method manipulates the verified plantar fibroma into aposition adjacent to a surface and/or a bottom of the patient's foot. Instep 440, the method positions a lasing device such that output poweremitted by that lasing device is directed onto the surface of thepatient's foot directly over the plantar fibroma.

In certain embodiments, step 430 further comprises applying a topicalmedication to the area of the foot directly over top of the plantarfibroma. Applicant's topical medication, which can be made in the formof cream, gel, ointment, and lotion, is made by a compounding pharmacy.The topical medication in the form of cream comprises Verapamil 15% byweight, Pentoxifylline 3% by weight, and Tranilast 1% by weight. Inother embodiments, the topical medication in the form of lotioncomprises Verapamil 15% by volume, Pentoxifylline 3% by volume, andTranilast 1% by volume. The medication is applied just prior to thelaser treatment and is allowed to absorb.

Applicant's topical medication is used to treat fibrotic conditions,like plantar fibromas, Dupuytren contracture, and scar tissues.Applicant has found that use of this topical medication assiststreatment of the fibrosis around the plantar fascia when used with theNd:YAG laser.

In certain embodiments, the lasing device of step 440 comprises a Nd:YAGlaser.

In step 450, the method configures the lasing device of step 440 to emitelectromagnetic energy in a beam comprising a about 5 mm spot sizediameter. In step 460, the method configures the lasing device such thatelectromagnetic energy emitted by that lasing device penetrates tissuesof the foot to a depth of between 6 mm and 8 mm. Applicant hasdemonstrated with magnetic resonance imaging that this tissue depth issufficient to reach the candidate plantar fibromas. A sonography studyhas shown that most plantar fibromas (nodules) are located superficiallyin the plantar fascia.

In step 470, the method energizes the lasing device for between about 10to about 15 minutes. In step 480, in certain embodiments, the methodnon-surgically delivers about 2,000 pulses of electromagnetic energy at15 J/cm², 6 msec and 7 Hz to the plantar fibroma. Step 480 does notinclude cutting of the patient's skin. More specifically, step 480 doesnot include cutting the patient's skin disposed over or adjacent to theplantar fibroma. Step 480 does not include closure of a previouslysustained wound.

In step 490, the method determines if (i) equals (N). If the methoddetermines in step 490, that (i) does not equal (N), then the methodtransitions from step 490 to step 492 wherein the method increments (i)by 1, i.e. sets (i) equal to (i+1), The method then transitions fromstep 492 to step 430 and continues as described herein.

If the method determines in step 490, that (i) does equal (N), then themethod transitions from step 490 to step 495 wherein the method reimagesthe plantar fibroma.

The following examples are presented to further illustrate to personsskilled in the art how to make and use the invention. These examples arenot intended as a limitation, however, upon the scope of the invention.

EXAMPLE 1

This Example 1 comprises an unsolicited testimonial from a patient ofApplicant.

“My Morton's Neuroma symptoms started a few years ago, beginning withbent toes and a tingling, burning sensation on the bottom of my rightfoot. Dr. Bocian treated me initially with cortisone injections, whichworked well for about a year each. Then the symptoms intensified and Ifelt like I was walking on a marble. Over a few months' time, I waslimping badly, causing pain in the left knee and leg. I started actuallycalculating how many steps I could avoid in daily activities.”

In October, I saw Dr. Bocian and asked what we could do short of surgeryso I could recover quality of life and normalcy of movement. He told meabout his laser treatment and I began the course of 10 immediately.After treatment no. 2, I felt 95% better.

I feel privileged to have been in Dr. Bocian's care and offered his newapplication of laser technology for Morton's neuroma.”

EXAMPLE 2

History: 58-year-old female with bilateral feet Morton's neuroma statuspost laser therapy for follow-up.

Comparison: Ultrasound of the right and left feet from 02107/2014.Technique: Focused grayscale and power Doppler ultrasound examination ofboth feet with attention to the forefoot was performed for follow-upbilateral Morton's neuromas.

Right foot: Redemonstrated is a round hypoechoic lesion at the plantaraspect of the second intermetatarsal space between the second and 3rdmetatarsal heads which has decreased in size and now measures0.2×0.2×0.2 cm (AP X TR X CC), consistent with a Morton's neuroma.Redemonstrated is a small fluid-filled lesion at the plantar lateralaspect of the 3rd metatarsophalangeal joint, measuring 5 mm in length,which is not contiguous with the Morton's neuroma, and may represent asmall adventitial bursa or a ganglion cyst. There is no additional softtissue abnormality at the remaining intermetatarsal spaces.

Left foot: Redemonstrated is a round heterogeneously hypoechoic lesionat the plantar aspect of the second intermetatarsal space between thesecond and 3rd metatarsal heads which has decreased in size and nowmeasures 0.3×0.2×0.1 cm (APX TR XCC}, consistent with a Morton'sneuroma. Redemonstrated is an additional ill-defined hypoechoic regionat the 3rd intermetatarsal space between the 3rd and 4th metatarsalheads which also has decreased in size and n w measures 0.1×0.1×0′.1 cm,which may represent an additional small Morton's neuroma. There are noadditional soft tissue abnormalities at the remaining intermetatarsalspaces.

Impression: Bilateral second intermetatarsal space Morton's neuromas andleft 3rd intermetatarsal space Morton's neuroma which have decreased insize when compared to reference examination.

EXAMPLE 3

Thirty (30) patients underwent a study evaluating the effect of a Nd:YAGlaser in the non-surgical treatment of Morton's neuroma. Baselinediagnostic MRI and/or ultrasound exams were used to confirm the presenceof a neuroma. A series of weekly laser treatments were given usingApplicant's method. Following completion of the treatments, subjectsreturned for a follow-up MRI and/or ultrasound study.

The results yielded an extremely high patient satisfaction rate.Follow-up comparison studies revealed a decrease in the size of theneuroma.

Of 42 patients undergoing Morton's neuroma evaluation by US, 21underwent treatment of a total of 32 Morton' neuromas. Retrospective USreview of the pre-treatment lesion showed heterogeneously, hypoechoicmasses with well-defined borders with associated pain on transducerpressure in 97% (31/32). An associated bursa (3/28) was identified in aminority of cases. Following treatment the lesions remainedheterogeneously hypoechoic but most demonstrated ill-defined borders(23/31) with significantly decreased or absent pain with transducerpressure (29/31). Statistical analysis revealed significant differencesin appearance of pre and post-treatment lesion borders (p<0.0001) andpain with transducer pressure (p<0.0001), as well as the presence of anassociated intermetarsal bursa (p<0.05), which resolved followingtreatment, but not size. Finally, all neuromas were determined to bebetter visualized on US compared to MRI.

Example 3 demonstrates that the use of a Nd:YAG laser in the treatmentof Morton's neuroma comprises an excellent option with satisfactionrates being superior to previous treatments. This procedure eliminatessurgical intervention along with its associated risks and complications.In addition, out of pocket expense for the patient is reduced. Moreover,there is no down time, and therefore, patients may continue to work andenjoy leisure activities such as golfing, cycling and tennis astolerable throughout the series of treatments.

EXAMPLE 4

History: 57-year-old male with left second inter space Morton's neuromastatus post laser therapy. Comparison: Prior left toot ultrasound datedNov. 10, 2014. Technique: Grayscale and Doppler ultrasound roots viewsof the left forefoot were obtained.

Findings: There is redemonstration of hypoechoic lesion within thesecond intermetatarsal space, measuring 0.4×0.4×0.3 cm (AP×TR×CC), whichis slightly decreased in size compared to prior study measuring0.4×0.5×0.3 cm. There is no significant interval change in theechogenicity or echo texture of this lesion. There is no pain withtransducer pressure, which is improved compared to prior study. There isno additional lesion within the remaining interspaces of tile left toot.

Impression: There is redemonstration of hypoechoic lesion within thesecond demonstrates slight interval decrease in size with no pain ontransducer pressure, consistent with successful treatment.

EXAMPLE 5

This Example 5 comprises an unsolicited testimonial from a patient ofApplicant.

“I became a patient of Dr. Bocian and in April 2015 after being referredby my primary care provider. I had been living with pain from a largeplantar fibroma on my right foot for 2 years. The pain had beenincreasing over the prior 6 months, which caused me to change mylifestyle to avoid jogging, standing for extended time and long hikes.Since February 2015, I would awake with painful cramping of the rightfoot in greater toe and would need to spend several minutes stretchingbefore I could walk comfortably.

I have had plantar fibroma surgically removed from my left foot twice inyears prior to this occurrence in my right foot. Both times my onlyoptions were to live with it or surgically remove it. I didn't care forthe long, painful and troublesome recovery from the surgery so I avoidedgoing back to the doctor for this new fibroma. After Dr. Bocianexplained the option of laser treatment versus surgery, I was stillhesitant about the treatment but I did not want to repeat the surgeryroute of treatment again. So I decided to give laser treatment a try.

The first 3 laser treatments were uncomfortable at times but Natasha(laser technologist) was very quick and skillful at easing the pain.With each further treatment, I noticed that the morning cramping andpain was disappearing and the nodules were getting softer and smaller.By the end of the treatment plan, I was not having any pain ordiscomfort in my right foot. The only time I had discomfort was afterwalking barefoot and stepped on a rock right on the fibroma. It did hurtfor a few moments.

Since finishing the treatment in July 2015 I've not had any pain orcramping of the right foot. My wife and I have gone on long and hardhikes with no discomfort to me. I still have the nodules, but they aresofter and smaller. I'm very happy that I took this path for treatment.I knew from the outset that Dr. Bocian could not promise the fibromawould go away but the pain and discomfort did. Thank you Dr. Bocian andNatasha.”

EXAMPLE 6

This Example 6 comprises an unsolicited testimonial from a patient ofApplicant.

“I told Dr. Bocian I was experiencing pain on the arch of my left foot.He sent me for a diagnostic ultrasound and explained I had PlantarFibromatosis. He suggested I try a fairly new laser treatment. I electedto follow his advice and get the laser treatment rather than havingsurgery to remove the fibromas.

My foot was so sensitive Dr. Bocian could barely touch it without mejumping out of my chair. Honestly, I was a little skeptical. The firsttreatment was awful and left me in tears. I was not looking forward tothe remaining treatments but knew I had to go through with them due tothe pain I was experiencing and the affect it was having on my qualityof life.

With each treatment, my foot was getting better and there was less andless pain. By the ninth treatment I was 100% better, the laser workedwonderfully and I couldn't be happier. I'm so glad I continued thetreatment each week. Jam back to dancing and getting my quality of lifeback.

When I went back to get my follow-up diagnostic ultrasound at Universityof Arizona Medical Center, the tech remembered me and told me shecouldn't believe the difference. She said when she did my firstultrasound, I would pull my foot away and now she was able to press onmy foot and there was no pain.

I want to thank Dr. Bocian and Natasha for being so patient with me. Mytreatments took longer than normal due to the sensitivity of my foot andthey had to keep stopping. I would recommend this treatment to anyoneexperiencing Plantar Fibromatosis and to not get discouraged after thefirst treatment! It gets better! Thank you again!”

EXAMPLE 7

This Example 7 comprises an unsolicited testimonial from a patient ofApplicant.

“I'm a nurse who works long 12 hour shifts. I began having pain in thearch and heel of my right foot a year and a half ago. As time went on,the pain got increasingly worse. The pain began affecting my daily life.I had spent hundreds of dollars on shoes, pain creams, and over thecounter orthotics with no help. I finally went to se Dr. Bocian and wasgiven all options from orthotics, laser, and surgery. Surgery was not anoption for me due to cost and down time. I opted for the customorthotics and laser. The price was much more affordable and no downtime! I will admit that I was a little skeptical about the laser atfirst, but I trusted in Dr. Bocian that this will work. By the time mytreatment coarse came to an end, I was amazed how well the laser worked!I am now back to doing the things in life that I had stopped doingbecause of the foot pain. I owe Dr. Bocian and his laser technicianNatasha a huge thank you!”

EXAMPLE 8

This Example 8 comprises an unsolicited testimonial from a patient ofApplicant.

“I am extremely happy with my laser treatment given by Dr. Bocian andNatasha, his assistant, for my painful plantar fibroma. They are bothvery skilled in using the laser and it is a very good option for thispainful condition.

It took away the discomfort and caused it to shrink away to almostnothing. I am back to walking and jogging and was able to do 6.6 mileswith no problem. Thanks again! I highly recommend Dr. Bocian's lasertreatment for Plantar Fibroma.”

EXAMPLE 9

This Example 9 comprises an unsolicited testimonial from a patient ofApplicant.

“Last July I limped into your office with a lump on the sole of my footand in severe pain. You diagnosed the lump as plantar fibroma. I had atrip to Yellowstone planned in 4 weeks, so you immediately started me ona series of laser treatments. The fibroma improved sufficiently in 4weeks, so that I was able to enjoy my trip.

Today, after 13 laser treatments, I am back to all my normal activitieswhich includes walking for exercise. I would definitely recommend lasertreatment for anyone suffering from plantar fibroma.”

While the preferred embodiments of the present invention have beenillustrated in detail, it should be apparent that modifications andadaptations to those embodiments may occur to one skilled in the artwithout departing from the scope of the present invention.

I claim:
 1. A method for treating a fibrous mass consisting of Morton'sneuroma in a human foot of a patient, the method comprising: identifyinga location of the fibrous mass in the foot using a medical imagingtechnique; determining a first size of the fibrous mass located;non-surgically delivering electromagnetic energy to the located fibrousmass during a treatment of a plurality of treatments to the foot, eachtreatment including: applying a topical medication in cream formdirectly on a skin surface at a location where each treatment of thelocated fibrous mass is being administered, wherein the topicalmedication comprises 15% verapamil by weight, 3% pentoxifylline byweight, and 1% tranilast by weight; emitting electromagnetic energy froma lasing device in a 5 mm diameter beam having a frequency of 7 Hz;directing the 5 mm beam onto the location to irradiate the fibrous massfor 15 minutes; and determining a second size of the fibrous mass aftera quantity of the plurality of treatments are delivered; and performing10 of the treatments, and thereby reducing a size of the fibrous massand softening the fibrous mass to an extent such that the patient isrelieved of disability resulting from the Morton's neuroma beyond merereduction in a pain level-associated with the fibrous mass.
 2. Themethod of claim 1, wherein the quantity of treatments consists of 10 ofthe treatments.
 3. The method of claim 1, further comprising: deliveringat least 1,000 pulses of the laser to the location, per treatment. 4.The method of claim 3, wherein the delivering electromagnetic energy tothe fibrous mass step further comprises: adjusting a power of the lasingdevice such that the electromagnetic energy penetrates the patient'sflesh to irradiate and thereby soften the fibrous mass at a depth of 6mm to 8 mm.
 5. The method of claim 4, wherein each of the pulses has anenergy of 15 Jcm2.
 6. The method of claim 4, wherein each of the pulsesis applied for a time period of 6 milliseconds.
 7. The method of claim3, wherein each of the pulses has an energy of 15 Jcm2.
 8. The method ofclaim 3, wherein each of the pulses is applied for a time period of 6milliseconds.
 9. The method of claim 1, wherein the deliveringelectromagnetic energy to the fibrous mass step further comprises:adjusting a power of the lasing device such that the electromagneticenergy penetrates tissues to a depth of 6 mm to 8 mm.
 10. The method ofclaim 9, wherein using medical imaging techniques includes usingultrasound.
 11. A method for treating a fibrous mass consisting ofMorton's neuroma in a human foot, the method consisting essentially of:identifying a location of the fibrous mass in the foot using a medicalimaging technique; determining a first size of the fibrous mass located;non-surgically delivering electromagnetic energy to the located fibrousmass during a treatment of a plurality of treatments to the foot, eachtreatment including: emitting electromagnetic energy from a lasingdevice in a 5 mm diameter beam having a frequency of 7 Hz; adjusting apower of the lasing device such that the electromagnetic energypenetrates tissues to a depth of 6 mm to 8 mm; directing the 5 mm beamonto the location for 15 minutes; and delivering at least 1,000 pulsesof the laser to the location, per treatment; wherein each of the pulsesis applied for a time period of 6 milliseconds; and wherein each of thepulses has an energy of 15 Jcm2 across an area impinged by the laserbeam; and determining a second size of the fibrous mass after a quantityof the plurality of treatments are delivered; and performing 10 of thetreatments, and thereby reducing a size of the fibrous mass andsoftening the fibrous mass to an extent such that the patient isrelieved of disability resulting from the Morton's neuroma beyond merereduction in a pain level-associated with the fibrous mass.
 12. Themethod of claim 11, wherein using medical imaging techniques furthercomprises using ultrasound imaging.
 13. The method of claim 12, furthercomprising using a Nd:YAG lasing device for the treatments.
 14. Themethod of claim 13, wherein, as a result of administering 10 of thetreatments, the size of the fibrous masses is reduced between 33% to66%.
 15. The method of claim 12, wherein, as a result of administering10 of the treatments, the size of the fibrous masses is reduced between33% to 66%.
 16. The method of claim 11, further comprising using aNd:YAG lasing device for the treatments.
 17. The method of claim 11,further comprising: delivering at least 2,000 pulses of the laser to thelocation, per treatment.
 18. The method of claim 17, wherein usingmedical imaging techniques further comprises using ultrasound imaging.19. The method of claim 17, further comprising using a Nd:YAG lasingdevice for the treatments.
 20. The method of claim 11, wherein, as aresult of administering 10of the treatments, the size of the fibrousmass is reduced between 33% to 66%.